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Meta-Analysis
. 2023 Aug 2;25(9):euad267.
doi: 10.1093/europace/euad267.

Targeted left ventricular lead positioning to the site of latest activation in cardiac resynchronization therapy: a systematic review and meta-analysis

Daniel Benjamin Fyenbo  1   2   3 , Henrik Laurits Bjerre  1   2 , Maria Hee Jung Park Frausing  1   2 , Charlotte Stephansen  1 , Anders Sommer  4 , Rasmus Borgquist  5 , Zoltan Bakos  6 , Michael Glikson  7   8 , Anat Milman  9   10 , Roy Beinart  9   10 , Radka Kockova  11 , Kamil Sedlacek  12   13 , Dan Wichterle  14 , Samir Saba  15 , Sandeep Jain  15 , Alaa Shalaby  15 , Mads Brix Kronborg  1   2 , Jens Cosedis Nielsen  1   2
Affiliations
Meta-Analysis

Targeted left ventricular lead positioning to the site of latest activation in cardiac resynchronization therapy: a systematic review and meta-analysis

Daniel Benjamin Fyenbo et al. Europace. .

Abstract

Aims: Several studies have evaluated the use of electrically- or imaging-guided left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) recipients. We aimed to assess evidence for a guided strategy that targets LV lead position to the site of latest LV activation.

Methods and results: A systematic review and meta-analysis was performed for randomized controlled trials (RCTs) until March 2023 that evaluated electrically- or imaging-guided LV lead positioning on clinical and echocardiographic outcomes. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization, and secondary endpoints were quality of life, 6-min walk test (6MWT), QRS duration, LV end-systolic volume, and LV ejection fraction. We included eight RCTs that comprised 1323 patients. Six RCTs compared guided strategy (n = 638) to routine (n = 468), and two RCTs compared different guiding strategies head-to-head: electrically- (n = 111) vs. imaging-guided (n = 106). Compared to routine, a guided strategy did not significantly reduce the risk of the primary endpoint after 12-24 (RR 0.83, 95% CI 0.52-1.33) months. A guided strategy was associated with slight improvement in 6MWT distance after 6 months of follow-up of absolute 18 (95% CI 6-30) m between groups, but not in remaining secondary endpoints. None of the secondary endpoints differed between the guided strategies.

Conclusion: In this study, a CRT implantation strategy that targets the latest LV activation did not improve survival or reduce heart failure hospitalizations.

Keywords: Cardiac resynchronization therapy; Clinical outcomes; Echocardiographic outcomes; Electrically; Guided; Imaging; Latest activation; Targeting left ventricular lead position.

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Conflict of interest statement

Conflict of interest: M.H.J.P.F. has received consulting fees from Medtronic outside the submitted work. C.S. has attended European Heart Rhythm Association (EHRA) device-exam preparatory courses held by Biotronik and Boston Scientific. S.S. has received research support from Abbott and Boston Scientific and Advisory Board work from Medtronic and Boston Scientific. J.C.N. received grants from the Novo Nordisk Foundation outside this work and is executive editor of Europace. All other authors declare no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Literature search and study selection.
Figure 2
Figure 2
Risk of the primary composite endpoint of all-cause mortality or heart failure hospitalization within 24 months between patients having the LV lead implanted either by targeting the latest activation site or by routine placement (targeted vs. routine). HF, heart failure.
Figure 3
Figure 3
Clinical improvement after 6 months as assessed by Minnesota Living with Heart Failure Questionnaire (A) and 6-min walk test (B) between patients having the LV lead implanted either by targeting the latest activation site or by routine placement (targeted vs. routine) or by an electrically- vs. imaging-guided strategy (EP-mapping vs. imaging).
Figure 4
Figure 4
Echocardiographic changes after 6 months as evaluated by LV EF (A) and LV ESV (B) between patients having the LV lead implanted either by targeting the latest activation site or by routine placement (targeted vs. routine) or by an electrically- vs. imaging-guided strategy (EP-mapping vs. imaging). EF, ejection fraction; ESV, end-systolic volume; LV, left ventricular.
See this image and copyright information in PMC

References

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